Providing safe care in the ambulatory setting is vitally important because of the sheer magnitude of care provided there. In any given month almost a quarter of people in the United States visit a physician in the ambulatory setting, compared to less than 1% that spend time as inpatients. Errors that lead to patient harm are well documented to occur in the ambulatory setting with medication errors having he highest risk for harm. We propose to improve the safety culture of the ambulatory care clinics of University of Colorado Hospital using errors in medication management as the learning substrate. Specifically, we will seek to improve: 1) chronic medication monitoring, particularly laboratory monitoring, 2) medication reconciliation and 3) timely review of monitoring results. We will evaluate the effectiveness and sustainability of the interventions developed using the Reach, Effectiveness, Economics, Adoption, Implementation and Maintenance (RE-AIM) model. We will create a tool kit for dissemination and a plan for dissemination of our findings. Our main thrust will be to facilitate the process of identifying, developing, testing, and implementing a series of interventions to improve medication management with the ultimate goal that the change process will become our institution's standard method of improving ambulatory patient safety, regardless of the targeted change or problem type. At the completion of this project, we will have refined the intervention processes, the practice level change processes and developed a toolkit that other institutions and ambulatory practices can use to identify, develop, test, and implement safe medication management practices in ambulatory care settings. PUBLIC HEALTH RELEVANCE: The Improving Ambulatory Medication Monitoring project is designed to improve the culture of safety and medication monitoring activities in the University of Colorado Hospital Ambulatory system while introducing a sustainable quality and safety improvement model.